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A TV journalist who has reported extensively on varied matters, from politics, religion, breaking news events to natural disasters. This is an attempt to create a space for larger and deeper issues that don't make the headlines. At least not enough

SNEHA

Inside a community centre at Mumbai’s Dharavi slum, Umair Khan teaches a group of young boys the difference between good and bad touch.

The 20-year-old is a community organiser with Sneha – Society for Nutrition Education and Health Action. He works with the NGO’s youth programme Ehsaas which, since 2013, has reached out to over 6,000 adolescents and youth between the ages of 15-24 in Mumbai’s slums.

As a young boy, Mr Khan experienced abuse. “The abusers were older boys in the neighbourhood. I was scared that I would be targeted again and it took me years before I spoke up. I don’t want anyone to suffer the way I did,” he tells NDTV.

At over 243 million, India has the largest adolescent population in the world, as per UNICEF’s 2011 report. However, down the decades, the focus of government programmes has been early marriage and early pregnancy, which is centered on young girls. Boys have been largely left out.

The National Family Health Survey (NFHS)-3 makes a compelling case for interventions among boys. Over 50% of boys between 15-24 years are in the labour force as per NFHS-3 data, while over 80% are married. One out of every five boys between 10-19 years is illiterate.

Over the years, there has been a growing realisation that there is an urgent need for specific interventions among young boys and men who too are victims of rigid gender norms. They struggle with notions of what constitutes a real man.

Being sexually active with various women is seen as a cultural sign of virility and the fallout is a lack of understanding of women’s rights.

Research has shown that men are also victims of many forms of violence, primarily at the hands of other men, and stand to gain from moving towards gender equality.

“Adolescent boys commit sexual crimes because there is a lack of appropriate orientation on sexuality and about matters like consent,” says Neeta Karaindikar, Associate Director, Ehsaas.

“Our films and advertisements show women in a very poor light and boys look at them as item numbers. We have to change this by working with the next generation, to make them see women as equal partners,” she adds.

Ehsaas does this through a mix of street plays and community meetings with adolescents and their families.

“Before I joined Ehsaas, I expected my sisters to do the household work,” says Shahid Shaikh, a community organiser.

“Now I know differently. We teach young boys to question stereotypes that allow boys to play outdoors but force girls into doing household chores. Gradually we are seeing a change,” he adds.

An impact report done six months after Ehsaas was launched in Dharavi has shown positive signs. Over 70% of boys and girls said that both genders should have equal freedom; nearly a 20% improvement.

Reaching out to boys comes with many challenges, as Pravin Katke, a coordinator with Equal Community Foundation points out. The foundation reaches out to boys between 14-17 years from low-income communities in the slums of Pune.

“In the areas that we work in, there is a high rate of school dropouts. There is also a tendency towards risky behaviour and addictions,” adds Mr Katke.

Through interactive sessions and games, the foundation tries to find out what is going on in the boys’ lives and the gender dynamics in the families.

“We have a curriculum where we talk about gender equality, violence, relationships, sexuality and adolescence,” says Mr Katke.

“We raise different situations and discuss their responses,” he adds.

To facilitate a larger change in the mindset, peer educators also meet with the parents every few weeks.

To prevent violence against women and build gender equality, one has to go back to the homes and communities where boys are raised, believes William Muir, co-founder, Equal Community Foundation.

“Boys across all environments are learning that successful men earn money and command respect through aggression and violence,” says Mr Muir.

“When you help them reflect on whether those messages are right or fair, they will start taking their own steps. The goal ultimately is to ensure that every boy is growing up in an environment where they are learning gender equality and in Pune, we are building that model,” adds Mr Muir.

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mMitra, started in Mumbai slums with the support of the civic body, is a free mobile voice call service that gives information on preventive care and simple interventions to reduce maternal and infant deaths. It is given in the language of the user’s choice and sent weekly or twice a week. Launched in 2014, it reaches over 5 lakh women in slums in Mumbai city, up to its far suburbs.

Domestic violence accounts for five in 10 of reported crimes against women in India. Many cases go undocumented, nearly 7 out of 10 women have suffered some form of domestic violence. Domestic violence is linked to posttraumatic stress disorder, gastrointestinal infections, suicide, chronic pain, and increased risk of unintended pregnancy, which, in turn, compromises maternal, infant and child health. The Little Sister’s Project, an initiative that works among victims of domestic violence in Mumbai, has 160 local women to identify and report incidents of gender violence using Android smartphones and an app called EyeWatch.

This documentary was done for the NDTV-Gates Foundation campaign, Every Life Counts. To watch click here

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A two-year-old app is helping women in Asia’s largest slum, Dharavi, to stand up against domestic violence. The Little Sister app, working in 3 languages, is helping women report instances, however small, and get help.

Home to a population of over one million, Mumbai’s Dharavi sees many such cases, say the women who are part of the initiative started in 2014 by a non-profit, SNEHA – the Society for Nutrition, Education and Health Action.

“Physical abuse and sexual violence is most common,” said Rashida, a sangini or worker in Little Sister.

Violence against women is listed as one of the top 10 reasons of death for women and domestic violence, also known as intimate partner violence, accounts for five in 10 reported crimes against women in India. Even so, many cases go undocumented, and various studies show nearly seven out of 10 women in India have suffered some form of domestic violence.

A report released last year by Population Reference Bureau, a Washington DC-based think-tank, said India — along with Nepal, Pakistan and Sri Lanka – shows a very high rate of violence, with one in three women reporting sexual and/or physical violence, mainly from a partner.

One of the many reasons why domestic violence goes unreported is because it has cultural sanction. “Everyone, including the mother-in-law, thinks the man has rights over the woman’s bodies, regardless of her feelings,” said Rashida.

“We recently counselled a woman who had been beaten by her husband for 22 years, right through their marriage,” added Saira Shaikh, another Little Sister sangini. “She kept thinking it was OK because her husband was providing for the family.”

Married twice, Rashida was abused both times. She finally found the courage to walk out when she nearly died after consuming poison in a fit of despair. “While in hospital I realised that by suffering violence, I was damaging my children.”

These are not easy decisions for any woman, especially those who are poor, uneducated and lack family support.

This is where the app greatly helps, believes Rashida – its biggest advantage being that women can express their pain in safety and secrecy, until they are ready to speak out.

Registering instances on the app gets immediate response.

Depending on what she wishes, the sanginis contact her and provide counselling. In case of physical violence, they can even contact the police and hold family counselling sessions.

“The project was designed to mitigate under-reporting of violence by providing a tool for women to record instances,” said programme coordinator Damini Mohan. “Most cases are reported to authorities as a last resort, when the violence has severely escalated. It helps us capture instances of violence at an early stage and helps us prevent its escalation.”

Since it was launched in June 2014, Little Sister has recorded 1,062 cases of domestic violence, compared to 200 cases recorded in 2013-2014.

While there are laws against domestic violence, what is not widely understood at the policy level are the health consequences, doctors say.

Women who suffer domestic violence are twice as likely to suffer from depression and about 50% more likely to become HIV positive. Other outcomes are post-traumatic stress disorder, gastrointestinal infections, suicide, and chronic pain. It is also linked with higher risk of unintended pregnancy that compromises maternal, infant and child health.

“Whenever there is violence, physical or otherwise, the physical impact shows up in the form of scars but the impact, internally, is 25% more,” said Praful Kamble of SNEHA. “There is depression, a sense of shock and a major impact on children who witness it. Even verbal abuse can affect pregnancy outcomes.”

This article was published on the NDTV website. To view the video report click here

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The lives of over 800, 000 children and 20 000 mothers could be saved each year with universal breastfeeding says a new series by the respected medical journal The Lancet.

Breastfeeding leads to fewer infections, enhanced IQ, probable protection against obesity and diabetes, even breast cancer prevention in mothers, says the series which has been hailed as the most in-depth analysis done so far into the health and economic benefits that breastfeeding can lead to. It also highlights that breastfeeding leads to economic savings of 300 billion dollars

The data published is based on analysis led by scientists at the Federal University of Pelotas in Brazil who looked at data from previous research.

Reporting on the findings, The Independent, a UK daily, quotes the study head Professor Cesar Victora as saying, “There is a widespread misconception that breast milk can be replaced with artificial products without detrimental consequences…. The decision not to breastfeed has major long-term negative effects on the health, nutrition and development of children and on women’s health.”

However, globally, only 37% of children under the age of six months are exclusively breastfed in low and middle-income countries.

Women avoid or stop breastfeeding due to many reasons ranging from medical, cultural, and psychological, to physical discomfort. Turning to formula milk, which is heavily pushed by multinational companies and many hospitals, becomes a convenient option.

There is a need to create a supportive environment for a mother who is breastfeeding says Dr Armida Fernandez, Founder, SNEHA. This includes addressing the many myths and misconceptions that are still widely prevalent.

“Mothers, and this includes women from poor backgrounds, want to breastfeed their babies. But if their baby keeps crying, and this happens due to many reasons, they feel it’s because they are not producing enough milk and so they resort to formula or diluted cow’s milk leading to malnutrition”, says Dr Fernandez.

She believes that doctors need to aggressively and consciously encourage breastfeeding.

“I find many doctors do not support it at all. The moment the baby is a little underweight they tell the mother to start a top feed. “ Dr Fernandez suggest that health centres and clinics must have counsellors on their staff who actively encourage women to breastfeed.

Currently India is still some distance away from reaching its targets on improving infant nutrition as per an assessment report by the Breastfeeding Promotion Network of India (BPNI) and Public Health Resource Network (PHRN) published in late 2015.

The report says that nearly 15 million babies, who comprise of 55% of newborns in India annually, are deprived of optimal feeding practices in their first year after birth.

The assessment also points to gaps in policies and programmes outlined for enhancing breastfeeding rates. Countries like Afghanistan, Bangladesh and Sri Lanka fare better than India in comparison.

Aggressive promotion of baby foods by companies, lack of support to women in the family and at work places, inadequate healthcare support, and weak overall policy and programmes were some of the reasons identified as responsible for lack of improvement in infant and young child feeding practice indicators.

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The beatings started just days after Anuradha,15, got married. Her husband was a distant relative, 12 years older to her. The marriage was an arranged one, and she soon discovered that her husband had a violent temper.

“The smallest thing would set him off”, says Anuradha, “If the tea was not the right temperature, or if I spoke to a neighbour. He would return home drunk late at night, beat me and force me to have sex.”

Anuradha’s inlaws were indifferent and her parents advised her to find ways to keep her husband happy. They finally intervened after she attempted suicide at the age of 17.

Domestic violence, also known as intimate partner violence (IPV), accounts for five in 10 of reported crimes against women in India. Many cases go undocumented, and various studies show that nearly seven out of 10 women in India have suffered some form of DV..

A report released last month by Washington DC-based thinktank Population Reference Bureau says that India, alongwith Nepal, Pakistan and Sri Lanka, reports among the highest rates in the world, with one in three women reporting sexual and/or physical IPV, predominantly from a husband.

One key reason why so many cases go unreported is because IPV has cultural sanction. According to the NFHS-3 survey, 57 per cent of boys and 53 per cent girls between 15-19 years believe that wife beating is acceptable in at least one circumstance.

Many women do not recognize that what they are facing is violence says Pouruchisti Wadia of SNEHA, a Mumbai charity that trains youth to conduct gender sensitization campaigns in slums in Mumbai.

“Younger brides have very poor negotiation skills. They also tend to believe that they have to play a subservient role, and that satisfying their partner’s sexual needs whenever he wishes is an implicit aspect of the deal. The idea that they can say “no” is not considered at all”, adds Wadia.

While there are laws against domestic violence, what is not widely understood and taken cognizance of, even at the policy level, is that it has enormous public health consequences.

“Our research in India has also demonstrated intersections of IPV and other forms of abuse and mistreatment that create a web of vulnerability for women and girls”, says Dr Anita Raj, Director, Center on Gender Equity and Health, University of California, San Diego, who has conducted extensive research on sexual and reproductive health and gender-based violence

“Women married as children are more likely to experience abuse from husbands. Among married women, sexual violence from husbands is most common among adolescent wives. These issues compromise mental health and have been linked to depression and high suicides in the region”, says Raj.

While the law prohibiting child marriage has helped bring down numbers significantly, they persist in rural areas due to ingrained traditional practices and rigid gender roles.

Beliefs that organizations like SNEHA and the Institute of Health Management in Maharashtra, are trying to tackle in pioneering ways. Since 1996 IHMP has been working in parts of Marathwada, among marginal farmers and landless labourers.

“Early marriage is an expression of the discrimination that girls suffer in patriarchal societies and we believe the answer lies in empowering girls”, says Dr Ashok Dyalchand, Director, IHMP.

IHMP’s programs include life-skills training, educating girls about their rights, and counseling. The average age of marriage among girls in IHMP’s focus areas used to be 11-12 years. Now 71 per cent get married at 18.

“The fact is that parents are decision makers and girls have to be taught how to negotiate”, says Dyalchand. “A major component of our program is engaging with and educating parents. When we tell them that their girls face a five times higher risk of morbidity when they marry young, it makes a difference.”

In 2013 the program was scaled up to include newly married couples to tackle domestic violence. “Our experience is that domestic violence should get addressed when it is initiated. Otherwise it becomes a norm”, he says.

Tackling IPV calls for a substantial change in attitudes and behaviors. Worldwide, there is growing acknowledgement that working with adolescents and youth is the most effective approach – one that needs as much as investment and commitment as rehabilitative responses.

A few months short of his first birthday, Sushma’s firstborn died. Underweight at birth, Vicky was always sickly and suffered from frequent diarrhea.

A ragpicker, Sushma lives in Govandi, home to one of Mumbai’s largest slum colonies and an area that reports a large number of malnutrition-related deaths.

According to a recent study, 6000 children die everyday in India and nearly half of them are malnutrition-linked. Mumbai alone reports 26000 deaths every year.

“The maximum deaths due to malnutrition take place between six months and two years”, says Dr Armida Fernandez, founder-trustee, SNEHA, the Society for Nutrition, Education and Health Action, a Mumbai-based non-profit which seeks to address the needs of women and children in urban, underprivileged communities by working with the public health system. “The problem is that the ICDS program takes on children after they turn three years old and by then the damage is done”.

ICDS or the Integrated Child Development Scheme is a government welfare program that provides food and health facilities to children below the age of 6 as well as their mothers.

The problem, experts say starts as at a very early stage.

“Girls are often treated as less valuable and their health and nutrition is accorded low priority,” says Shreya Manjrekar, a program coordinator with SNEHA. “When she gets pregnant, her poor nutrition level affects the baby.”

Early marriage and high teenage pregnancy rates add to the problem. And compounding it is the lack of awareness about exclusive breastfeeding and nutritious diet.

Exclusive breastfeeding for six months after birth is widely established as an effective way to reduce malnutrition and ensure that every child has a fighting start in life.

Not only does early and exclusive breastfeeding help children survive, it also supports healthy brain development, improves cognitive performance and is associated with better educational achievement at age 5. Breastfeeding is the foundation of good nutrition and protects children against disease. In this and many other fundamental ways, breastfeeding allows all children to thrive and develop to their full potential

What goes into a nutritious diet

Breastfeeding also contributes to maternal health because it helps reduce the risk of postpartum haemorrhage after delivery. In the short term, it delays the return to fertility and in the long term, it reduces type 2 diabetes and breast, uterine and ovarian cancer.

Yet myths and misinformation regarding breastfeeding are plenty.

“I did not nurse my children but fed them cow’s milk because that is better for health. I told my daughter-in-law to do the same” says Alka, Sushma’s mother-in-law.

Her neighbor Usha adds, “I started nursing my daughter three days after she was born because the first milk is dirty and it should be thrown out”. She has never been told that the first milk or colostrum contains antibodies that are essential to build immunity.

Counselling by SNEHA workers

The impact of this lack of awareness finds reflection in India’s infant mortality rate. At 1.34 million under-five deaths, India reports the highest IMR according to a 2014 UN report. Many of these deaths can be prevented with breastfeeding.

“A major problem we see is that of stunting”, says Dr Fernandez. “Babies in India are getting shorter”. This too is attributed to under-nutrition in the first 1,000 days of a baby’s life, including during gestation.

To bust such myths and promote nutrition in this crucial 1000 days period, SNEHA holds yearly camps called Aahar in areas that are home to a large number of informal settlements or slums.

One in six of Mumbai’s population lives in slums, and many of them live under the threat of constant displacement. Like Sushma, they have no fixed means of income and often travel long distances for work. In such a scenario, food takes the lowest priority.

Using street theatre to tackle malnutrition

By using innovative strategies and tools like flash cards, puzzles, games and videos SNEHA counsellors work with the ICDS staff to promote awareness about breastfeeding techniques, complementary feeding, and healthy cooking practices.

Apart from this, SNEHA also holds workshops and sessions where they directly engage with the communities. “We do this through home visits and group meetings where we demonstrate healthy methods of cooking”, adds Manjrekar.

“We reach out to not just mothers, but all the women in the community because the decision on what to feed is not entirely in the mother’s hands. The in-laws play a big role”, says Anagha Waigankar, associate program director, Aahar. “We also educate the mothers about immunization, hygiene and care during illness because if the women change their habits about cooking and child care, it benefits the entire family.”

An internal impact assessment report by SNEHA shows a 35% reduction in wasting through 2 ½ years of intervention.

India’s urban population is estimated to double to over 800 million over the next five years. A quarter of them, nearly 200 million, will live in poverty, in slums like Govandi.

The solution to tackling child malnutrition lies in models like Aahar that can be scaled up to address a critical public health issue that has direct economic implications on India’s national growth.

At the end of his weekly sessions with a group of adolescents from Dharavi, Umar Khan noticed that Faisal* had taken to hanging around long after the others had left.

“I felt he had something on his mind, so I would find reasons to stay back,” says Khan, 21.

After three weeks, the 10-year-old blurted out that a neighbourhood “uncle” was giving him the bad touch — a concept that had been discussed at the sessions.

It turned out that the “uncle” abusing Faisal was a neighbour. Faisal would be left in his care at night, while his mother worked as a security guard. A widow, she struggled to make ends meet. Faisal didn’t know how to talk about his plight.

With Khan’s support, Faisal did eventually tell his mother. She got the abuser arrested.

“I know what it’s like to feel alone and vulnerable,” says Khan who was 11 when three older boys from the slums he grew up in started abusing him sexually. Raised by a single mother, he was mostly left to his own devices while she worked multiple jobs to make ends meet.

“The abusers were people I considered friends, so I was very confused and ashamed. I suffered for three years before I worked up the nerve to tell my mother,” recalls Khan.

It is this empathy that Khan brings to his role as peer educator for the Society for Nutrition, Education & Health Action (SNEHA), an NGO. Since 2013, SNEHA’s youth programme EHSAAS has reached out to 6,000 adolescents and youth between the ages of 15-24, in Mumbai’s slums.

Through theatre, sports and workshops, SNEHA focuses on rights-based education to help explain the importance of physical, sexual and reproductive health.

At 243 million, India has the largest number of adolescents in the world, comprising a third of its population. But they do not receive the due attention of government health programmes.

That needs to change. A 2012 Population Council report says that 85 per cent of young people in India lack access to sexuality education, which exposes them to risky or forced sexual activity, multiple partners, early pregnancies, even HIV.

“Unless you show youngsters how to negotiate their sexuality, you are not empowering them with skills to prevent early marriage and violence,” says Programme Director Dr Nayreen Daruwala.

Awkward topics like masturbation are discussed at the sessions, using terms youngsters employ.

“There is a lot of shame and guilt about natural bodily functions,” says Shahid Shaikh, a 19-year-old peer educator. “They don’t know whom to ask, and believe that watching porn regularly helps build a good physique”.

Shahid Shaikh, Peer Educator, SNEHA

Sessions on body image are especially popular. “All the girls want to look like Katrina and the boys like Salman,” he says. To dispel popular notions of beauty, pictures of stars sans make up are shown. “We encourage them to look at their strengths and build on that, instead of worrying about skin tone or height,” says Shaikh.

A preliminary impact assessment shows encouraging signs. A 2013 survey in the slums showed that only 64 per cent of boys believed that when a girl said ‘no’ she meant it. By 2014, this had grown to 84 per cent. Knowledge of reproductive health among adolescents had risen from 44 per cent to 82 per cent, while 88 per cent showed improved gender attitudes, as against 69 per cent.

Since late 2014, SNEHA has tweaked its approach. “Given how gender inequality plays out in many subtle ways, we decided to involve the parents for a substantial attitudinal change,” says Daruwala.

She points to the case of two siblings. The girl, a TB patient, needs good nutrition, but it is the brother who gets the eggs and meat, while she is fed dal-roti. There are many such instances, says Daruwala. “With school-going children, only sons get tuitions and pocket money”.

Parents are asked to fill out forms with questions about their children, to gauge their awareness of their children’s lives. “We talk to them about communication,” says Gouri Ambekar, a programme coordinator. “What to tell children when they are going through difficult situations, and the importance of staying engaged with their kids.”

Ambekar cites the instance of a 14-year-old, whose uncle raped and impregnated her. Although her condition was visible, the girl’s mother wouldn’t take her to a doctor because she didn’t want to acknowledge what was happening. “The mother felt powerless and had no idea how to cope because it would have meant confronting the elders in the household.”

Findings apart, there are others signs of hope. Like Faisal, many children are coming forward to report instances of domestic violence and sexual abuse.

“An 11-year-old approached us recently, saying her father beat her mother,” says Sanna Meherally another programme coordinator. “The mother was reluctant to seek help, but the child insisted and brought her to the centre”. In another instance, three children sought help for a girl who was being sexually abused by an older boy.

Like Khan, many peer educators see the initiative as an opportunity to pay it forward.

“When I was 14, I was confused and helpless and felt I was worth nothing,” says Shaikh. “So I am happy that I am making a difference. Even at home I have been able to bring about a change. I convinced my father to let my sister study and wear what she likes to. It may not sound like much, but it makes a world of a difference to me.”